Severe hemolytic anemia and excessive leukocytosis masking mycoplasma pneumonia

Abstract

The formation of cold agglutinins is frequently observed during Mycoplasma pneumoniae infections. Nevertheless, severe hemolysis is exceptional. We report a case of life-threatening hemolytic anemia caused by M. pneumoniae. As the leucocyte count was excessively elevated, the differential diagnosis primarily comprised hematological malignancies. The presence of cold agglutinins indicated the correct diagnosis, which was confirmed by highly elevated levels of both IgG and IgM antibodies to M. pneumoniae and a chest X-ray suggestive of atypical pneumonia. The patient was treated with roxithromycin and showed a favorable recovery within ten days after admission. This case demonstrates that, even in patients with clinically mild pneumonia, M. pneumoniae may be the cause of severe anemia.

Mycoplasma pneumoniae associated with severe autoimmune hemolytic anemia: case report and literature review

“…The coincidence of elevated serum levels of lactate dehydrogenase and bilirubin with low levels of haptoglobin is common in hemolytic anemia caused by cold agglutinins [5]. Our patient showed both features of extra-and intravascular hemolysis.…”

“…An increase in cold agglutinin titers is frequently observed during M. pneumoniae infection; it has been reported that 50%-60% of these patients had cold agglutinins [9,10], which appear one week after the onset of the illness and decline toward undetectable levels after two to six weeks [5]. Cold agglutinins appear to be more specific for I antigen of the red blood cell surface and often result in mild, subclinical hemolysis and mild reticulocytosis.…”

“…Antibiotics are likely to be of limited value in mycoplasmaassociated hemolytic anemia [5]; however, treatment of the underlying mycoplasma infection has been associated with more rapid resolution of the hemolytic process [14]. Furthermore, in the setting of an autoimmune hemolytic anemia, packed red blood cell transfusions can potentiate hemolysis, and their use should be limited [13].…”

“…In the latter site, it is contained in long-chain sialooligosaccharides that serve as receptors for M. pneumoniae. The induction of cold agglutinins may be triggered by the formation of mycoplasma-receptor complexes, in which the lipid-rich mycoplasma surface plays the role of an adjuvant [5].…”

“…Cold agglutinins were presumed to cause antibody mediated hemolysis in 10% of the patients [4]. Nevertheless, severe hemolysis is exceptional [5,6]. We report a case of severe autoimmune hemolytic anemia secondary to Mycoplasma pneumoniae infection in a 29-year-old man.…”